RESUMO
We studied 40 cases of Hodgkin's disease (HD) from Costa Rica for evidence of Epstein-Barr virus (EBV) in the Reed-Sternberg and Hodgkin (RS-H) cells. We also compared the epidemiologic features of these patients with previous reports of HD in industrialized and developing nations. Because Costa Ricans enjoy a relatively higher standard of living than the residents of other developing Central American nations yet live in the same general geographic region and are genetically similar, we believed that this comparison might shed additional light on the hypothesis that the prevalence of EBV in HD and the epidemiologic factors of HD are influenced by socioeconomic factors. In 16 (40%) of 40 cases, immunohistochemical studies demonstrated that the RS-H cells were positive for EBV latent membrane protein (LMP), including 1 case of lymphocytic depletion analyzed, 12 (86%) of 14 cases of mixed cellularity, and 3 (15%) of 20 cases of nodular sclerosis. All five cases of lymphocytic predominance were negative. In the 16 EBV LMP-positive cases, polymerase chain reaction studies revealed that the virus was type A in 12 cases and type B in 4 cases. Nodular sclerosis was the most common type of HD, accounting for 20 cases (50%), followed by mixed cellularity, with 14 cases (35%). The relatively low prevalence of EBV in the RS-H cells of HD and the high incidence of nodular sclerosis in Costa Rica are similar to industrialized nations and are unlike HD in neighboring Central American countries. These findings further support the hypothesis that the prevalence of EBV in HD and the epidemiologic features of HD are most closely linked with socioeconomic conditions, and geographic location or ethnic heritage are of relatively less importance.
Assuntos
Herpesvirus Humano 4/isolamento & purificação , Doença de Hodgkin/virologia , Adolescente , Adulto , Idoso , Costa Rica/epidemiologia , Feminino , Herpesvirus Humano 4/classificação , Herpesvirus Humano 4/genética , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/patologia , Humanos , Imuno-Histoquímica , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Células de Reed-Sternberg/química , Células de Reed-Sternberg/virologia , Fatores Socioeconômicos , Proteínas da Matriz Viral/análiseRESUMO
BACKGROUND: T-cell lymphomas may involve the subcutaneous tissue as a manifestation of generalized disease. However, T-cell lymphomas rarely present with extensive involvement of the subcutaneous fat without other sites of disease. OBSERVATIONS: We describe 2 women who presented with fever and subcutaneous nodules or masses. In case 1, the nodules were generalized and did not respond to chemotherapy. The patient died 2 months after diagnosis. In case 2, the mass was large but localized and responded to chemotherapy. The tumor subsequently recurred in a cervical lymph node 9 months later, and the patient was being treated with chemotherapy 15 months after initial diagnosis. Histologically, biopsy specimens from both patients revealed malignant lymphoma involving the subcutaneous tissue. The dermis and epidermis were not involved. At low power the lesions resembled panniculitis, but high-power examination revealed cytologic atypia of the malignant lymphoid cells. Immunohistochemical studies revealed T-cell lineage. In case 2, the neoplastic cells also expressed the CD30 antigen, were positive for Epstein-Barr virus RNA, and carried the t(2;5) (p23;q35) chromosomal translocation. We interpreted case 1 as an example of subcutaneous panniculitic T-cell lymphoma. We believe that case 2 is best classified as anaplastic large cell lymphoma of T-cell lineage. CONCLUSIONS: A variety of T-cell lymphomas rarely present with only subcutaneous tissue involvement. Knowledge of this phenomenon and recognition of the cytologic atypia of the lymphoid cells will help to prevent misdiagnosis.